If possible, ask OPQRST and SAMPLE questions.Ĭhapter 10 Shock 405Secondary AssessmentPhysical Perform a systematic full-body scan beginning with the head, looking for DCAP-BTLS.Examinations Assessment should be rapid if the patient has a poor general impression. Monitor patient for change in mental status. Be alertChief Complaint for injuries and life threats. Identify signs and symptoms and pertinent negatives. For an unconscious patient, perform a primary assessment, performa rapid full-body scan, obtain vital signs, and if possible, obtain the past medical history from a family member,bystander, or emergency medical identification device.History TakingInvestigate Investigate the chief complaint. Do not delay transport to manage non–life-threatening injuries, instead treat en route to the hospital.NOTE: The order of the steps in this section differs depending on whether the patient is conscious or unconscious.The following order is for a conscious patient. If anaphylactic shock is suspected, determine if the patient has a prescribed EpiPen auto-injector before leaving the scene. ALS providers can treat these patients with intravenous fluids to support circulation (shock) problems. Suspected shock patients or those with a suspicious MOI should go to a trauma center. Serious bleeding must be treated at once.Transport If the patient has an airway or breathing problem, significant external bleeding, or signs andDecision symptoms of internal bleeding, consider rapid transport. Place the patient in a supine (Trendelenburg’s) or shock position. If distal pulses are not palpable, assess for a central pulse. Provide high-flow oxygen at 15 L/min and evaluate the depth and rate of the respiratory cycle, providing ventilatory support as needed.Circulation Evaluate distal pulse rate and quality observe skin color, temperature, and condition look for life-threatening bleeding and treat accordingly. Quickly assess the chest for DCAP-BTLS, accessory muscle use, intercostal and abdominal muscle use, and treat any threats to life. A patient with an altered level of consciousness may need emergency airway man- agement consider inserting a properly sized oropharyngeal or nasopharyngeal airway. A rapid scan will help you identify and manage life threats.Airway and If a cervical spine injury is suspected, open the airway using a modified jaw-thrust and ensure theBreathing airway is patent. If the patient has a poor general impression, call for ALS assistance. Determine priority of care based on the MOI/NOI. Observe overallImpression appearance of patient and body position. Observe the patient for signs of NOI suchNature of Illness as urticaria, chest pain, or fever.(NOI)Primary AssessmentForm a General Determine level of consciousness and find and treat any immediate life threats. Observe the scene and look for indicators of the MOI such as falls,Injury (MOI)/ motor vehicle crashes, gunshot wounds, or stabbings. Consider the number of patients, the need for additional help/ALS, and cervical spine stabilization.Mechanism of Determine the MOI/NOI. Standard precautions should include a minimum of gloves and eye protection. 404 Section 5 Shock and ResuscitationScene Size-upScene Safety Ensure scene safety and address hazards.
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